How Orthopedic Physical Therapy Supports Women During Menopause

The changes in hormones during perimenopause and menopause affect almost everything in the body. But these changing hormone levels alone aren’t 100% to blame. They often make already existing issues worse.

For example, if someone is already struggling with low energy availability (not eating enough to support activity), the hormonal changes of menopause will make symptoms like brain fog and fatigue feel more intense. The same is true for bone density and muscle strength. If you already have borderline low bone density and muscle strength, the hormone changes during menopause can make it worse.

One of the biggest misconceptions about staying active during menopause is that you need to exercise completely differently or in a “special” way. That’s not true. While it's important to consider the hormone changes you are going through, the basics of exercise still apply. Keep reading to learn how physical therapy can help you navigate the symptoms of perimenopause and menopause.

Bone Density

Your bones are constantly remodeling, meaning they naturally break down and rebuild themselves frequently. Cells called osteoclasts break bone down, and osteoblasts build bone back up.

During menopause, the decrease in estrogen activates osteoclasts more, which means your body starts breaking down bone faster than it can rebuild it. This is why bone density often decreases and the risk of osteoporosis rises after menopause.

But hormones aren't the only thing that affect bone health. Bones respond incredibly well to load (Watson et al., 2018). According to Wolff’s Law of biomechanics, the more stress you put on your bones, the more they will adapt to build up more bone and strengthen. That’s why weight training and impact activities — things like squats, deadlifts, and jumping — are some of the best tools we have to stimulate bone density.

The older we get, the more important these activities become. The irony is, many people stop doing these activities as they get older because they think they’re too dangerous. The truth is that with good form, appropriate loading, and the right guidance, these movements are not only safe but essential. And if things like knee pain or back issues are holding you back, a fitness-forward physical therapist can help you work through those issues. That way, you can still safely include these bone-building activities in your exercise routine.

Muscle Strength

Just like with bone density, declining estrogen affects muscle mass. As we age, the amount of muscle fibers we have naturally decreases. This is called sarcopenia. Decreased estrogen levels after menopause accelerates that process.

However, the decrease in muscle fibers can be offset by increasing the size of the muscle fibers you have left through resistance training. That means you can still preserve and even build muscle strength as you age.

Building muscle allows you to continue daily activities with ease, like standing up from a chair or toilet, gardening, playing with grandkids, or carrying groceries. It helps you maintain independence and confidence for years to come.

And remember, you don't need to start training differently after menopause. The basics of strength training still work. The main difference is that recovery may take a little longer than it did in your 20s or even 30s.

Unfortunately, joint pain without an obvious injury (arthralgia) and adhesive capsulitis ("frozen shoulder") are also common during perimenopause and menopause. While the exact cause of these conditions are not known, the decrease in estrogen is thought to play a role. Fortunately, a fitness-forward physical therapist can help navigate these issues to keep you staying active.

Vasomotor Symptoms and Fatigue

Vasomotor symptoms (AKA hot flashes and night sweats) are one of the main symptoms of menopause. It can majorly disrupt your daily life, affecting sleep and draining your energy.

Good sleep hygiene can help improve the quality of your sleep so that sleep disruptions from night sweats don't affect you as much. And regular exercise has been shown to reduce the intensity of hot flashes (Liu et al., 2022). It won’t eliminate hot flashes entirely, but it can make them more manageable and improve overall energy levels.

If you aren't already exercising regularly, the thought of starting might seem overwhelming, especially if the weather is warm. But doing the following can help you navigate exercising while experiencing hot flashes:

• Stay hydrated

• Use a fan if needed

• Dress in layers to help regulate temperature

• Adjust workouts based on your energy levels for the day

Takeaway

Menopause brings many changes, and for many women it is an unwelcome reminder that they’re aging. That often comes with the belief that you have to slow down, give things up, or stop doing what you love.

That’s simply not true. You can absolutely maintain the same lifestyle you had before menopause. It just takes more mindfulness while you manage your symptoms and adjust to your new normal.

Physical therapy can help you navigate the changes menopause brings and keep you active, strong, and confident for decades to come.

If you’re ready to keep moving with confidence through menopause, click below to book an appointment.

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References

Liu, T., Chen, S., Mielke, G. I., McCarthy, A. L., & Bailey, T. G. (2022). Effects of exercise on vasomotor symptoms in menopausal women: a systematic review and meta-analysis. Climacteric : the journal of the International Menopause Society, 25(6), 552–561. https://doi.org/10.1080/13697137.2022.2097865

Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284